Professional requirements: Public Servants: consultants/fully qualified specialists or senior registrars Volunteers: consultants/fully qualified specialists or registrars (="Assistenzärzte" in Switzerland) A few notes: Be flexible and open for everything. A retired Swiss GP, who intended to spend about six months as a volunteer doctor in Solomon Islands wrote: Perhaps I am simply too old to drop all my habits acquired during my professional life in Switzerland, but I found it most difficult to cope with the different kind of working methods: to make a diagnosis without a blood pressure gauge, a stethoscope, or even a simple flashlight. To quickly prescribe antibiotics, but pay less attention to simple rules of hygiene or antisepsis like washing hands, skin cleaning, removal of pus, etc. Dr Oberli comments: Never forget: thousands of patients have been treated under less than ideal conditions in Solomon Islands. Thirty years ago, when I entered the only OT in Samoa for the first time, I felt like working in a not overly clean laundry. Two years and more than 100 major stomach operations later, I had a slightly different attitude... Diagnostic work is based on a precise medical history, good clinical examination and limited or no technology (imaging, laboratory). A Swiss student wrote in Summer 2004: It is really amazing, how local doctors (especially consultants) can rely on their power of observation and their palpation skills. Because many diagnostic means of the Western world are simply not available (e.g. CT), the local doctors are probably much more experienced in diagnosis by observation and palpation than some of our doctors at home with access to all kinds of facilities, and for us students it is always worth peeking over a doctor's shoulder during a status assessment. A Swiss volunteer registrar, who intended to stay three months, wrote: Since I knew that anesthesiology was a limiting factor in the hospital, I had spent two months in a department of anesthesiology before I came here. I informed the superiors about this, but was nevertheless assigned to Orthopedics. From my point of view this was a misassignment of resources. Dr Oberli comments: In government administered hospitals only fully qualified anesthetists are allowed to work on their own, and even then some initial training period will be required. Therefore the registrar could just have assisted a specialist, but with only one specialist available, this would not have helped improve the situation. Your initiative is required. If you look for it, you will find many useful things to do, but the chronically overworked doctors will hardly have the time to point it out to you. For the same reason, don't expect much introduction to your work. The registrar cited above wrote: I was never properly introduced to my work. Nobody showed me the forms used or explained the general work routine in the department. Registrars should be willing to be on duty and accept responsibility according to their experience. The registrar wrote: Duty service was never mentioned, I was simply put on duty after two weeks. Working as a registrar in a provincial hospital requires the presence of a fully qualified specialist in this hospital. If you expect a fully qualified specialist in your field of interest to be present during your volunteer time, ask before you apply. But here is no guarantee that a knowledgeable superior is always present, as the previously cited registrar found out: After my first work week in Orthopedics, my immediate superior went on vacation, then caught malaria, and finally appended another week of vacation. It was rather frustrating, because whenever I had questions regarding orthopedics, I was referred to my absent superior. In a country, where medicine is quite different from what I am used to, I just did not get the support I had expected. As I was not prepared to do operations I had never done before under supervision, the conditions for me were less than ideal. [Note: Unfortunately, at this time Dr Oberli had already left Solomon Islands and the hospital was without an Orthopedics specialist.] He continued: After one month I came to the conclusion that coming here as a specialist is probably more rewarding for the volunteer and the hospital, and decided to terminate my stay. Altogether I had an interesting time, but I do not regret having left early. Working at NRH: being a fully qualified specialist allows you to train others. Experience in or extensive knowledge of tropical medicine not required, but of course an asset. Working in a provincial hospital: well trained and experienced nurses usually handle most routine cases, therefore you, as a doctor, are expected to take care of the more complex ones. This requires a broad general medical knowledge as well as some practical experience in gynecology, anesthesiology, and minor surgery. Again, some experience in or knowledge of tropical medicine is an advantage. Be aware, that your resources (available instruments and drugs) will often be very limited. Availability of other things may also be limited as the Swiss GP cited above reported: The little hospital is run quite well, especially the reproduction ward. There were only two patients, both well looked after given the limited resources available. Laundry was only possible with cold water as the washing machine no longer worked because a hose was missing. The hospital could not provide meals for the patients, the patients' families had to feed them. I unsuccessfully tried to find another accommodation, as staying in the hotel would have been too expensive in the long run. There were only two shops in town, where one could buy oil, rice, tuna and soap, but nothing else. The GP decided to return to Honiara and leave Solomon Islands again after about one month. Minimum duration of stay: Volunteers: minimum should be three months, but since it takes about eight to ten weeks until you are productive in the new environment, you should stay at least four months, preferably six or more. Public Servants: one year, usually two years Part time work (e.g. for couples): Most likely possible, ask when you apply. Remuneration: In any case, ask when you apply. As volunteer for up to 6 months: usually none at all, i.e. you will have to pay for your travel costs, accommodation, food, etc. As volunteer for 6 months or more: you may get a small allowance, but do not expect much. If you are lucky, you might even get free housing. As Public Servant: ask. Accommodation provided: For volunteers: the Jubilee House (not for free) for registrars at NRH if a room is available, otherwise you have to organize something on your own For Public Servants: hopefully free housing is provided. Source
